Most Clinicians Still Do Not Know About MACRA

Major financial penalties loom for providers not following reporting requirements.

We are more than halfway through the first year of the Medicare Access and CHIP Reauthorization Act (MACRA), and a majority of clinicians still do not understand the program.

In fact, the Centers for Medicare & Medicaid Services (CMS) reported that an estimated 40 percent of providers are unaware of the MACRA requirements, and even fewer provider extenders, such as nurse practitioners and nurses, understand the program.

The deadline to start tracking data under the Merit-Based Incentive Payment System (MIPS) is quickly approaching. CMS made some adjustments for more than 800,000 doctors who are getting a “pass” based on practice size and Medicare patient volume, but over 400,000 providers are being required to report under MIPS this year.

MACRA became law in 2015 with the Quality Payment Program. The affiliated financial penalty is to begin in 2019, based on 2017 compliance. Data reporting requirements kicked in on Oct. 2.

Just a reminder, under the MIPS Quality Payment Program: there will be a 4 percent penalty payment in 2019 for data not reported after Oct. 2, and each year that figure grows. At this point, if providers do not report by 2020, there will be a 9 percent reduction in payments. Under the Alternative Payment Model (APM, which most providers have elected not to consider, since it is high-risk, it seems like an Accoutable Care Organization operating under a modified bundled payment program, with significant stress on the coordination of care for the patient.

In spite of a great deal of information being readily available and the new buzz in the healthcare arena, again, still, a majority are not well-informed about MACRA. Maybe after the other mandates – such as those put in place by the Patient Protection and Affordable Care Act (PPACA), electronic medical records (EMRs), and bundled payments – no one is taking it seriously. Some thought the new Republican control of all three branches of government meant that they didn’t have to do much of anything. Unfortunately, many electronic health record (EHR) systems are not prepared to support the clinical care function operating under the new program. None report the requirements with MACRA.

Now, providers and EHR vendors are not the only guilty parties. CMS has not outlined exactly how providers will be judged under these two programs. One suggestion I would make is to review a web resource from the American Academy of Family Physicians MACRA Ready materials, available online at http://www.aafp.org/practice-management/payment/macraready.html.

Program Note: Listen to Lyman Sornberger discuss MACRA on Talk Ten Tuesdays today at 10 a.m. ET.

Facebook
Twitter
LinkedIn

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24